NURS 3046 Nursing Project Assignment Help.

NURS 3046 Nursing Project           

Instructions:-

Background

The prevention of falls among older adults is an urgent public health issue in Australia and internationally (Nyman & Skelton 2017; Gillespie, Robertson, Gillespie, Sherrington, Gates, Clemson, et al. 2012).

The proportion of Australians aged 65 years and over is predicted to increase from 14% (3 million people) in 2010 to 23% (8.1 million people) by 2050 (Intergenerational Report, 2010). By 2051, the Australian total annual health costs from fall-related injury are predicted to increase almost threefold to $1.4 billion (Moller 2003). Approximately 30% of adults aged 60 and older will fall during the period of a year (Tinetti 2003; Resnick 1999). Falls by older adults are a common occurrence and a leading cause of dependence (Stevens, Corso, Finkelstein & Miller 2006).  Falls can result in injuries, reduced confidence, isolating social consequences, and a reluctance to continue physical activity that, not surprisingly, can be a precursor to other health-related complications. Nearly 30% of people over the age of 65 will sustain a fall every year in residential care facilities, and fall-related injuries are the leading cause of mortality and morbidity (Cakar, Dincer, Kiralp, Cakar, Durmus & Kilac 2010). Notably, three quarters of injuries to older adults that require hospitalization are the result of falls (AIHW: Bradley 2013) The rate of falls by older adults in residential aged care facilities is nearly three times higher than the rate of falls in other settings (Shi 2014).

There is compelling evidence that physical activities to enhance balance and strength are among the most promising exercise-based interventions to prevent falls and fall-related injuries in older adults (Gillespie et al. 2012). Moreover, ‘widespread implementation of exercise as a single intervention seems to be the best approach to falls prevention’ (Sherrington, Tiedemann, Fairhall, Close & Lord 2011, p. 78). Balance and strength training and lower limb resistance training is known to reduce falls in older adults (Sherrington, Whitney, Lord, Herbert, Cumming & Close, 2008). However, less than 10% of older people routinely engage in strength training and even less in activities that strengthen their balance (Clemson, Fiatarone Singh, Bundy, Cumming, Manollaras, O’Loughlin & Black 2012).

Research question: What is the effectiveness of exercise-based interventions in reducing falls in older adults living in residential care facilities?

This research question is relevant for evidence-based clinical practice and professional knowledge.  If exercise-based intervention programs have positive effects on reducing falls among older people, then this approach could change the way older adults are cared for in residential care facilities. This research question could generate evidence to inform person-centred care planning regarding effective exercise-based interventions for falls prevention and targeted education for older adults living in residential care facilities (NMBA 2016). Findings could provide local and international nurse leaders and managers with strategies to improve holistic care for older adults living in residential care facilities. Nurse educators could also use the evidence to promote effective strategies in the undergraduate nursing curriculum.

SummarY ANALYSIS of Four (4) Primary Research Articles (1000 words)

Select four (4) primary research articles (from the 8 articles provided) that you think provide relevant evidence to answer the research question. Write a 250 word summary analysis of each primary research article using the three step format learned in Topic 2.

Paper 1

Paper 2

Paper 3

Paper 4

Discussion (850 words)

Compare, contrast and synthesise the findings of the four (4) primary research articles using the approach learned in Topic 3. Ensure the analysis explains why EACH primary research article selected is relevant and how the quality of the findings enables you to answer the research question. Identify any existing gaps in knowledge or practice. Discussion may be supported by additional relevant additional literature.

Conclusion (150 words) Summarise the major points in a synthesised non-repetitive manner, discuss future directions for research

Solution

NURS 3046 Nursing Project           

Background

The prevention of falls among older adults is an urgent public health issue in Australia and internationally (Nyman & Skelton 2017; Gillespie, Robertson, Gillespie, Sherrington, Gates, Clemson, et al. 2012).

The proportion of Australians aged 65 years and over is predicted to increase from 14% (3 million people) in 2010 to 23% (8.1 million people) by 2050 (Intergenerational Report, 2010). By 2051, the Australian total annual health costs from fall-related injury are predicted to increase almost threefold to $1.4 billion (Moller 2003). Approximately 30% of adults aged 60 and older will fall during the period of a year (Tinetti 2003; Resnick 1999). Falls by older adults is a common occurrence and a leading cause of dependence (Stevens, Corso, Finkelstein & Miller 2006).  Falls can result in injuries, reduced confidence, isolating social consequences, and a reluctance to continue the physical activity that, not surprisingly, can be a precursor to other health-related complications. Nearly 30% of people over the age of 65 will sustain a fall every year in residential care facilities, and fall-related injuries are the leading cause of mortality and morbidity (Cakar, Dincer, Kiralp, Cakar, Durmus & Kilac 2010). Notably, three-quarters of injuries to older adults that require hospitalization are the result of falls (AIHW: Bradley 2013) The rate of falls by older adults in residential aged care facilities is nearly three times higher than the rate of falls in other settings (Shi 2014).

There is compelling evidence that physical activities to enhance balance and strength are among the most promising exercise-based interventions to prevent falls and fall-related injuries in older adults (Gillespie et al. 2012). Moreover, ‘widespread implementation of exercise as a single intervention seems to be the best approach to falls prevention’ (Sherrington, Tiedemann, Fairhall, Close & Lord 2011, p. 78). Balance and strength training and lower limb resistance training are known to reduce falls in older adults (Sherrington, Whitney, Lord, Herbert, Cumming & Close, 2008). However, less than 10% of older people routinely engage in strength training and even less in activities that strengthen their balance (Clemson, Fiatarone Singh, Bundy, Cumming, Manollaras, O’Loughlin & Black 2012).

Research question: What is the effectiveness of exercise-based interventions in reducing falls in older adults living in residential care facilities?

This research question is relevant for evidence-based clinical practice and professional knowledge.  If exercise-based intervention programs have positive effects on reducing falls among older people, then this approach could change the way older adults are cared for in residential care facilities. This research question could generate evidence to inform person-centred care planning regarding effective exercise-based interventions for falls prevention and targeted education for older adults living in residential care facilities (NMBA 2016). Findings could provide local and international nurse leaders and managers with strategies to improve holistic care for older adults living in residential care facilities. Nurse educators could also use the evidence to promote effective strategies in the undergraduate nursing curriculum.

Roderidah, E., Nordin, E. & Nyberg, L., 2007. A randomized controlled trial of fall prevention by high-intensity functional exercise program for older people living in residential care facilities. Aging clinical and experimental research, 20(1), p. 67.

            The aim of this research was to determine the effectiveness of high-intensity functional exercise program to older people living in residential facilities.  In this research, the sample population involved 191 older people who were dependent on basic life activities.  These participants were subjected to high-intensity functional programs for a period of 3 months to determine the effectiveness of exercise to fall incidents. The outcomes measured were the proportion of participants sustaining a fall and fall rate. After 6 months of follow-up, the participants were examined for fall rate and walking balance. From the research findings, the people who achieved high balance during the exercise period recorded a substantial decrease in the falling (exercise 2.7 fall per PY, control 5.9 falls per PY). It is for this reason that it was concluded that high-intensity exercise programs lowered the chances of falling for the old people who attain body balance during the training.

            According to this report, falling causes increased the rate of inactiveness and can cause death due to injury. The report further admits that older people in residential facilities have high chances of falling compared to people in homes due to the inactive state they are subject to while at the facilities. Additionally, the authors admit that there are no defined single ways to proves that the certain exercises are more effective in reducing the fall than others. According to this report, the existing discrepancies and inconsistencies in finding by different researchers create a room for further studies and necessitate the use of the opposing and support views to create consensus.    

Alvarez-Barbosa, F. & Zhang, Y., 2014. Effects of supervised whole body vibration exercise on fall rise factor, functional dependence and health-related quality of life in nursing home residents aged 80+, s.l: Elsevier Ireland Ltd.

The aim of this research was to test the effectiveness of whole-body vibration (WBV) therapy on the falling risk in residents’ home residents who are aged 80+ years. The sample population was 29 people aged between 80-95 years who volunteered for the research. The tests conducted for measuring the outcome were Test up and Go (TUG) for functional mobility, Barthel index was used to test functional dependence and EuroQol (EQ-5D) test was used to evaluate the quality of life. From the test results after 8 weeks, TUG test was (p< 0.001), EQ-5D mobility (p<0.001) and EQ-5Dutility (p<0.001). From this results, it is was concluded that WBV was effective in reducing the fall and improving the quality of life to the person aged 80+ years.

According to research number 4, many old people fall while in the residential facilities. It is estimated that 30% of old people above the age of 65 years’ experience a fall at least once per years.  Further, the report argues that the flexibility of muscle decrease with age and therefore the reduced muscle strength cause the higher chances of fall. The authors show that the effect of the fall of the old result to mortality, morbidity, higher cost of health care, hospitalization of the fallen old persons and higher social cost. The research further suggests that the use of high-frequency yields better results than lower-amplitude dose strategy. The report recommended that the combination of vibration and amplitude dose increases the muscle strength and lower the chances of fall.

Faber, M., Paw, c. & Bosscher, R., July 2006. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter Randomized controlled trial, s.l.: American Congress of Rehabilitation Medicare and the America Academy of physical medicine and Rehabilitation.

According to the research number 5, the research was conducted to test the effects of moderate intense group exercises. It was conducted in multicentre for a period of 20 weeks and later a 52-week follow-up was conducted. The sample population was 287 men and women aged 85years and above. During this research, different exercises were conducted in various quarters and they included in-balance and functional walking and the main outcomes from the exercise were falls, physical performance score, and Performance Oriented Mobility Assessment (POMA).  The fall incidence rate was recorded to be higher in functional walking (3.3 falls/y) compared to IB (2.4falls/y). The results of the research indicate that the chances of fall in the pre-frail reduced with the exercise. This was noted after 11 weeks of training (Hazard ratio of 0.39 and confidence interval of 0.18-0.88). For the frail, the chances of fall increased as they engaged in the exercise.

The data from the research shows that the intensity of the exercise has a positive outcome to people without disabilities but it increases the chances of fall to people with disabilities. The lack of functioning of some body parts especially the lower appendages causes increase chances of fall. Frailty has been associated with worsening the mobility, reducing the activities of daily living and hospitalization and sometimes can lead to death. The study further shows that exercise can reduce frailty, prevent it ability or better still reverse the frailty process. From the report, it was concluded that trainability of the aged is possible and that by exercising, the old people in the Community homes can have adequate muscle exercises. The research advocate from further studies in the effects of exercise on gait, endurance, and disability. 

Cakar, E, Dincer, U, Kiralp, M, Cakar, D, Durmus, O & Kilac, H 2010, ‘Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility’, European Journal of Physical and Rehabilitation Medicine, vol. 46, no. 1, pp. 59-67.

            The researcher in this project aimed at determining if combined regular exercise which involves stretching, aerobic and jumping improve the balance, reduce the chances of fall and lower the depression status of the older people. In this study, a sample population of 168 old people in the residential home was involved in the exercise. The participants were group into combined exercise program (COM) and COM plus jumping group. In this exercise, 66 people managed to finish the trial. The exercises carried out at the program included aerobic, strengths and stretch and additional jumping sessions. The observable parameters at the end of the exercise include the risk of fall, improved balance, the quality of life and depression condition of the older people.  The training periods involved the warm-up, training programs which were intense and the cooling of sessions. To reduce counter-effect the exercise period was regulated to 45 minutes and results were recorded. The methods of the test were Berg balance test and Biodex Balance system for access the balance and risk of falling. Geriatric Depression Scale was used to evaluate the depression status of the participants.

            According to the results of the research, the risk to fall and an improved balance was noted among the participants of the exercise however, the people who engaged in jumping showed a better improvement. Emerging exercise to jumping, aerobic exercises and stretching give additional benefits of fall risk reduction and balance improvement. The quality of life improved in after the exercise session. From this research, it was concluded that long-term exercise in a group setting has the positive effects of balanced improvement, fall risk reduction and increased quality of life.

Discussion

From the above four pieces of research,  there are similarities and various difference on the way the research was conducted and the measurement parameters used, however, the four had common conclusion that chances of fall increase with age as a result of weaker muscular functioning. The different approaches used therefore were trailed towards the strengthening of the muscle and improving body balance. According to research number 4, 5, 6 and 7, fast and consistent exercises have the effect of improving body balance and consequently reduce the chances of falling.  Similarly, the four pieces of the research argued that people who live in home facilities are more prone to falling due to reducing physical activities and general dependence in the all daily activities. The three activities advocated for in these pieces of research are a high-intensity exercise program, use of vibration and jumping combined exercises.

Although the suggestion present in papers 4,6 and 7 show the positive effect of exercise on the aged, research paper 5  gives a different perceptive of the issues. The research conducted in this paper indicates that exercise to flail can be disastrous and it has effects of increasing the chances of falling. The research further shows that frail participants showed slight or no improvement based on the Performance Oriented Mobility Assessment (POMA). For this reason, the research advocates for increased investigation of the possible ways of reducing the falling to in this group of elders. Unlike the other groups, when giving the training to flail group, the level of supervision should be intense to ensure safety. In the four pieces of research, the training sessions were doing under supervision though the time difference in the training differed. From these researches, it is clear that in group setting close supervision is important as the sessions could have counter-effects.

Report number 6, unlike the other reports, makes an honest point and suggestion that there is no single exercise method which can be used to reduce fallibility of the old people. This report further presents a contradicting position by suggesting there are some pieces of research which have shown that exercising does not reduce falling and in some case, it increases the chances of falling. This position is supported by the lack of sufficient evaluation to show the input or effect of each physical activity. The three exercises mentioned in these pieces of research show the positive effect of exercise among the aged in residential facilities however this does not mean all exercise which engages the old are beneficial. Research by (Tiedemann & Lord, 2013) shows that dancing, golf, yoga, and use of lawn bowls as a single activity to prevent falling of the old. The gap existing between single interventions exercising program versus multiple interventions need further research.

Another common position of the four research is that muscle inflexibility and reduced physical activities increase the chances of falling this may be due to reducing the psychological functioning of the body as people age. The exercise suggested above are aimed at creating a balance and mobility, strengthening the muscles, increasing the reaction time and increasing the ability to perform various activities in life. The activities carried out, vibration, jumping, and high-intensity exercise have common similarity, they are individually prescribed intensity and they involve vigorous training. An observation of the nature of the training further indicates that the level of training change depending on the age of the participants. In the four pieces of research, the targeted group is old people aged 80+ years and it was given home-based individualized kind of training. For the octogenarians, the training serves the purpose of increasing muscle endurance, giving balance and strength however for old people aged 60-80 the training given can be more vigorous with high endurance

Australian data indicates that the residents of aged-care facilities are about one-eighteenth of the total older population and the gross cost of their fall therefore significant in the health system. The projected cost of health which the government incurs after the aged fall necessitated recommendation to prevent the aged from falling in the care facilities. The falling in the health care facilities cannot be purely categorized as a random event but can be predicted to be caused by visual impairment, foot pain, vitamin D deficiency, poor nutrition, cardiac arrhythmia, impaired balance and reduced lower appendages muscle strength (Leguisamo, 2013). The knowledge of the cause of the fall is the basis of determining the appropriate ways to prevent the fall. From this research, there is evidence that exercise can prevent falls of the aged in the community cares for the aged.

            According to research by NCBI (Hewitt & Henwood, 2014), The potential direct benefits of the exercise for the older people in RACFs are reduced chances of falling and the effects of the falls thus a lower rate of mortality, injury, morbidity, loss of confidence and hospitalization. Improving the flexibility of residents with severe mobility complication may increase their chances of fall, however, giving 50 hours exercise, strength work for the deconditioned aged people, giving exercises individually, high-level balance exercises and the use of walking programs reduces the risk of fall (Refshauge & Clemson, 2015). The benefits of exercise improve the musculoskeletal health, reduced number of falls and physical conditions like sarcopenia. The relevance of these studies is that exercise effectively increase balance and lower the estimated risk of fall

Conclusion

            Sensorimotor and balancing decrease with an increasing age and impairment these inabilities increase the chances of fall. From the chosen four research papers, it is suggested that physical exercises increase the muscle strength, gives the old people the balance and reduces falling especially for the group in residential facilities. Analysis of the four research also points to the ineffective state of residential facilities, where the older people are more vulnerable to fall compared to when at home. This position raises concern in the patient safety, the state of the facility and the availability of resources to take in Medical Centres. Lower the chances of fall will improve the well-being of the aged and reduce healthcare burden. Encouragingly, these research show the role of exercise in older age and confirms that more active people have fewer falls. However, despite the positive effect of exercise, it was noted that future studies should consider ways of engaging the frail and the pre-frail older adults as the approaches used currently proves to be nonworking. Future study should also focus on the general benefits of single exercise activity in order to enhance effective training.

References

AIHW: Bradley, C 2013, Trends in hospitalizations due to falls by older people, Australia 1999–00 to

2010–11. Injury research and statistics no. 84. Cat. no. INJCAT 160. Canberra: AIHW.

Alvarez-Barbosa, F. & Zhang, Y., 2014. Effects of supervised whole body vibration exercise on fall rise factor, functional dependence and health-related quality of life in nursing home residents aged 80+, s.l.: Elsevier Ireland Ltd

Cakar, E, Dincer, U, Kiralp, M, Cakar, D, Durmus, O & Kilac, H 2010, ‘Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility’, European Journal of Physical and Rehabilitation Medicine, vol. 46, no. 1, pp. 59-67.

Clemson, L, Fiatarone Singh, M, Bundy, A, Cumming, R, Manollaras, K, O’Loughlin, P & Black, D 2012, ‘Integration of balance and strength training into daily life activity to reduce the rate of falls in older people (the LiFE study): randomised parallel trial’. British Medical Journal, 345:e4547 doi: https://doi.org/10.1136/bmj.e4547 

Faber, M., Paw, c. & Bosscher, R., July 2006. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter Randomized controlled trial, s.l.: American Congress of Rehabilitation Medicare and the America Academy of physical medicine and Rehabilitation.

Gillespie, LD, Robertson, MC, Gillespie, WJ, Sherrington, C, Gates, S 7 Clemson, LM 2012, Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9 Art. No. CD007146. doi: 10.1002/14651858.CD007146.pub3

Alvarez-Barbosa, F., & Zhang, Y. (2014). Effects of supervised whole body vibration exercise on fall rise factor, functional dependence and health-related quality of life in nursing home residents aged 80+ . Elsevier Ireland Ltd.

Hewitt, J., & Henwood, T. (2014, Feb 21). Do progressive resistance and balance exercise reduces falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program. Retrieved July 11, 2017, from The National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937111/

Leguisamo, C. P. (2013). Effect of physical exercise program on the balance and risk of falls in institutionalized elderly persons: a randomized clinical trial. Retrieved July 11, 2017, from http://www.scielo.br/pdf/rbgg/v19n3/1809-9823-rbgg-19-03-00473.pdf

Refshauge, K., & Clemson, L. (2015, October). NNSW Falls Prevention Forum. Retrieved July 11, 2017, from University of Sydney: http://fallsnetwork.neura.edu.au/wp-content/uploads/2015/01/NNSW-Falls-Forum_October-2015_JHewitt_for-email.pdf

Roderidah, E., Nordin, E., & Nyberg, L. (2007). A randomized controlled trial of fall prevention but high-intensity functional exercise program for older people living in residential care facilities. Aging clinical and experimental research, 20(1), 67.

Tiedemann, A., & Lord, S. (2013, Sep). The Role of Exercising for Fall Prevention in Older Age. Retrieved July 11, 2017, from University of Sydney, Australia: http://www.scielo.br/pdf/motriz/v19n3/02.pdf